This application is a resubmission of a competing continuation for the National Institute of Mental Health grant "Psychiatric and Physical Health Effects of Caregiving" (MH 46015). This revision addresses the measurement and analyses concerns identified by the review committee. The current study was designed to be carried out as an ancillary study of the Cardiovascular Health Study (CHS) of the elderly. The CHS is a prospective, epidemiologic study designed to investigate the etiology and natural history of cardiovascular disease and its clinical sequelae in persons 65 years and older. A population based sample of 5888 was recruited to participate in the CHS. It is now in its 7th year of data collection and is currently funded to the year 2001. The purpose of the Caregiver Health Effects Study (CHES) is to assess the physical and psychiatric health effects of spousal caregiving in a population-based sample of elderly persons aged 65 and over. Our sample of 819 caregivers/controls is drawn from the CHS sample and therefore takes advantage of the sampling, recruitment, and vast quantities of physical health data and measurement expertise available from the CHS. The CHES represents a unique opportunity to assess the long-term health effects of caregiving as well as characterize the natural history of caregiving in a large, representative population. Our primary aims continue to be the assessment of short- and long-term psychiatric and physical health effects of caregiving. We propose to extend data collection for the CHES cohort for an additional four years and expand our efforts in two directions: 1) We will study transitions into the caregiving role by continuing to follow our cohort of more than 400 control who had no caregiving responsibilities at baseline. This will enable us to assess the health effects of caregiving prospectively; 2) We will assess the health effects of transitioning out of the caregiving role when the care-recipient dies. Mortality rates among care-recipients are high enough in this study to enable us to examine the effects of bereavement in a relatively large sample of elderly spousal pairs.